Emergency medicine journal : EMJ
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'Normal' range for cardiac troponin I (TnI) has changed with more sensitive tests, but the validity of low-level elevations is contentious. We aimed to describe the characteristics and outcome of patients with an initial TnI level 1-5 times the upper limit of normal. ⋯ Approximately half of patients with initial TnI between 0.05-0.19 ng/ml had a TnI rise consistent with ACS. An initial TnI in this range is not, of itself, indicative of ACS. Clinical decision-making should be guided by clinical features and serial TnI measurement.
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Intranasal opiate analgesia is the first choice in children presenting to paediatric emergency departments with severe pain. A prospective observational study was performed which showed that intranasal fentanyl is a safe effective alternative to diamorphine.
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Case Reports
Extension avulsion fracture of the upper thoracic spine with associated oesophageal injury.
This case report describes a case of a high-speed injury in a patient with preexisting spinal segmentation abnormality, leading to anterior corner avulsion fracture of T1 and oesophageal perforation. As well as being indicative of anterior ligamentous injury, bony fragments associated with hyperextension injuries may injure adjacent viscera or vessels, and clinicians should consider the possibility of clinically occult visceral or vascular damage if such a fracture is demonstrated. Conservative management of both injuries was successful in this case.
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Recent consensus guidelines state that acute myocardial infarction (AMI) may be diagnosed in the context of a troponin rise above the 99th percentile of the upper reference limit (URL) with the optimal imprecision of the assay (coefficient of variation, CV) being
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This paper discusses recent developments in research support for ambulance trusts in England and Wales and how this could be designed to lead to better implementation, collaboration in and initiation of high-quality research to support a truly evidence-based service. ⋯ New structures to support the strategic development of ambulance and prehospital research will help address gaps in the evidence for health interventions and service delivery in prehospital and ambulance care and ensure that ambulance services can increase their capacity and capability for high-quality research.